Hello. My mom (with dementia) was discharged against my wishes from her former nursing rehab. They said there was nothing more they could do for her. She was discharged to her housemate who lives in her house and is of limited help. A couple of weeks later, her housemate found her unresponsive due to low blood sugar. I got her into a better rehab facility and she is much better. Today, her current facility wants me to decide if she should be released or kept long term. I am trying to find bandwidth to manage everything long distance.
The issue is she has a house, cats and an older housemate who keeps the house "afloat." If she stays in the nursing home long term then most of her assets will go to her care and the house will have a lien.
The problem with that is, her housemate can not afford the expense of a house. Her cats are there also and I am afraid she will become depressed without her cats. It sounds silly but they have been keeping her going.
I fear unless there is a way to get a Medicaid home aid for her meds, cleaning and meals, loosing her home will be a bad situation for her mental health, the housemate and cats. Is the best course to keep her in the nursing home and break the bad news to her housemate?
This is a continuing series of events. Very sorry I keep posting. It seems just when things calm down a little everything breaks loose.
Although someone has to - who has legal authority to do so?
You say you are not the POA. Who is?
It seems to me that you have to do what is required for the best care of your mother - whatever that is.
Yes, of course, give the roommate notice to vacate... get rid of the cats. This is no time to keep things as they are. (Unless you decide to keep your mom in her home at a huge caregiver expense - which doesn't seem like the optimal course of action.)
IT SOUNDS CRITICAL that 'if you can," make a trip there to manage everything that is time sensitive 'now' / required to do so.
Or
Hire / get someone to manage it all.
Whoever has legal authority is the person you need to speak to.
If you are in a position to need to make decisions, do it now.
You do what is necessary and needed for the best care for your mom now.
Whatever that means. You do not need to be 'sorry' for posting. This is what we are here for.
This is a 'continuing series of events' (seemingly) due to you not making definite needed decisions to move forward as needed.
Yes, of course, things break down and then everything breaks loose.
This is what happens as a person declines.
You need to make a decision to 'take charge' and do what is necessary.
You are not there and I sense you need to be.
If you cannot, someone who is able and has legal authority needs to take charge.
Hire someone - an attorney - a social worker. Someone who can act on your behalf if you are not able to make needed decisions.
Gena / Touch Matters
The biggest hurdle in this drama, is the mom won’t place the OP as her POA. The OPs hands are tied to carry out any actions needed.
When she went to Rehab a couple of weeks later, her 20 days did not start over. Lets say Mom got in 30 days at last Rehab, then at new she starts at 31, meaning she needs to pay 50% of the daily cost of care.
Medicaid in home, the help you get really determines the Stste you live in how many hours you can get. My cousin was able to get 8 hrs a day, 5 days a week. The rest of the time he covered.
As kindly as possible it’s time to tear off the metaphorical bandaid. A wrecked house and a diabetic coma aren’t the keys to happiness but directing the care facility to get her into long term care where she will regain her physical health as much as possible at least gives her the opportunity to become happy. Nobody’s happy to lose their faculties and be confused and afraid but residential care sounds like her best chance.
Telling her the minimum is a great idea. However she will want to see her hone and cats as she gets regular visits.
If there is no house to return to, one less issue to deal with. You need to do what is best for her, safety first, she will have to accept that she can no longer live in her home.
In my area there are facilities where a resident can have 1 small pet.
You are long distance.
It seems at this time she must leave the home.
She requires long term care now unless you are willing to accept that he going back home may well result in her death. To tell the truth, as I am now 82, it seems to me an option to pass at home with less stellar care than to last another year or two in good care but quite unhappy.
Have you been to the home?
Does the housemate get any funds to care for mom? Is this a personal relationship between the two of them or are they simply roomies? Have you discussed situation with the housemate for HIS/HER wishes, thoughts? Have you been there and assessed the home? For safety and other things? Have you discussed with your mother? Are you the POA? Do you handle the bills?
So many questions here need answering but the truth is that you have choices to make. A move to care may result in grief and an early death as much as staying at home may at this point. You need to visit and fully assess the situation as it is.
Heres my suggestions: the current SNF / rehab place has been through this before, I would ask for an in person care plan meeting to discuss having them contact APS to get involved, and APS asks the court for a temporary guardian to be named so that they can do a spend down so mom can get her $ to whatever point it is for NYS LTC Medicaid. So mom can segueway from a rehab patient on health insurance to a custodial resident on private pay or LTC Medicaid. (fwiw NY has a higher asset limit than most & it’s abt 31K). So the new guardian spends down her $, pays the NH, puts her home up for sale and does whatever needed to get that housemate moved out. Housemate is technically a tenant so has the whole eviction process and as the guardian is local plus has court ordered authority they can get the eviction done more efficiently than you could. The new rehab SNF will be ok on billing delays as that guardian will ensure they get paid. Try to go to the house and get whatever items mom can use, family stuff you want and if at all possible take the cats to live with you.
Probably what happened with old NH was that mom said she has a FT caregiver in the home who would come to get her; and mom insisted on returning home, so technically looks like safe discharge. Plus they were likely completely over dealing with her 50/60K bill not being settled. You don’t want this happening again.
please realize that if she goes onto LTC Medicaid, it has a required Share of Cost of almost all her monthly income to be paid to the NH. So due to the SOC, she will not have any $ to pay the costs on her home. House bills currently on auto pay will bounce as the NH will get her income. She won’t be able to pay taxes or maintenance bills. If the housemate is dependent on mom’s $ to keep the lights on, this becomes another crisis. It’s going to be a lot of things to deal with. Let the Guardian do it. You can petition the court to become her Guardian once the temporary period ends
The NH said for long term care with medicaid. , her income would go to them less 50. The housemate would not be evicted, however the house would be shut down unless he can pay the bills. His call.
A Medicaid aid will not be there every day to give her meds. She may need to pay other in-home aids to cover the other days. FYI there seems to be high turnover in the aids sent through the Medicaid waiver. You will still be managing things from afar.
Your Mom's housemate is not your problem. She is an adult who had lots of time to plan for her future and this eventuality.
"Is the best course to keep her in the nursing home and break the bad news to her housemate?" IMO yes. You can tell your Mom a therapeutic fib: that her doctor says she can be assessed for discharge when she can demonstrate all her ADLs to her/him. This way she will be upset at the imaginary doctor, and not you.
You may need to take a leave for several weeks to get things put into place and deal with the roommate. It will be very hard at first and then things will eventually not be in crisis mode.
I wish you wisdom and peace in your heart as you help your Mom get appropriate care.